在肺癌手术时实施戒烟计划的经济效益
2010/01/07
背景：许多患者在诊断外科手术可切除的肺癌时是主动吸烟者。围手术期戒烟与生存改善是相关的，但是在手术前立即启动戒烟计划的花费-效益并不清楚。
方法：建立一个马尔可夫分析模型以评价一个正式戒烟计划的增加的花费-效益。参数估计来自于可用的文献。模型包括戒烟计划的花费和效益、成本和围手术期并发症的发生率、手术后死亡率以及以生活质量调整的生命年(QALY)的效用。计算每一生活质量调整的生命年的花费美元额并进行单向敏感度分析。
结果：手术后1年的每个生活质量调整的生命年(QALY)的花费及每个生命年的花费分别为$16,415 及 $45,629 ，手术后5年时为$2609 和 $2703。最大敏感性分析显示手术后1年的花费/QALY估计少于$50,000, 手术后5年时的花费低于$12,000。花费-效益估计对于围手术期并发症的频率以及短期效用估计都是非常敏感的。
结论: 在外科手术前启动戒烟计划的在手术后1年和5年评价的花费-效益性价比都是高的。医生应当鼓励仍在吸烟的患者参加正式的戒烟计划。
（张永明编译 刘国梁审校）
（张永明编译 刘国梁审校）
Journal of Thoracic Oncology. 4(4):499-504, April 2009.
Cost-Effectiveness of a Smoking Cessation Program Implemented at the Time of Surgery for Lung Cancer.
Slatore, Christopher G. MD, MS *+; Au, David H. MD, MS *+; Hollingworth, William PhD ++
*Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington; +Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington; and ++Department of Social Medicine, University of Bristol, Bristol, United Kingdom.
Background: Many patients are active smokers at the time of a diagnosis of surgically resectable lung cancer. Perioperative smoking cessation is associated with improved survival, but the cost-effectiveness of a smoking cessation program initiated immediately before surgery is unknown.
Methods: We developed a decision analytic Markov model to evaluate the incremental cost-effectiveness of a formal smoking cessation program. The parameter estimates were taken from the available literature. The model included the cost and effectiveness of the smoking cessation program, cost and incidence of perioperative complications, postoperative mortality, and utility measured in quality adjusted life years (QALY). Dollars per QALY and life year were calculated and one-way sensitivity analyses were performed.
Results: The cost/QALY and cost/life year were $16,415 and $45,629 at 1 year after surgery and $2609 and $2703 at 5 years, respectively. Most sensitivity analyses showed the 1 year postsurgery cost/QALY estimates were less than $50,000, and all were less than $12,000 at 5 years. Cost-effectiveness estimates were most sensitive to the frequency of perioperative complications and the estimated short-term utility estimates.
Conclusion: A smoking cessation program initiated before surgical lung resection is cost-effective at both 1 and 5 years postsurgery. Providers should encourage patients who are still smoking to engage in formal smoking cessation programs.
Methods: We developed a decision analytic Markov model to evaluate the incremental cost-effectiveness of a formal smoking cessation program. The parameter estimates were taken from the available literature. The model included the cost and effectiveness of the smoking cessation program, cost and incidence of perioperative complications, postoperative mortality, and utility measured in quality adjusted life years (QALY). Dollars per QALY and life year were calculated and one-way sensitivity analyses were performed.
Results: The cost/QALY and cost/life year were $16,415 and $45,629 at 1 year after surgery and $2609 and $2703 at 5 years, respectively. Most sensitivity analyses showed the 1 year postsurgery cost/QALY estimates were less than $50,000, and all were less than $12,000 at 5 years. Cost-effectiveness estimates were most sensitive to the frequency of perioperative complications and the estimated short-term utility estimates.
Conclusion: A smoking cessation program initiated before surgical lung resection is cost-effective at both 1 and 5 years postsurgery. Providers should encourage patients who are still smoking to engage in formal smoking cessation programs.
Accession Number 01243894-200904000-00010.
DOI Number 10.1097/JTO.0b013e318195e23a
